Saturday, October 16, 2004

Microchips, mega-concerns...

Implantable microchips may soon provide doctors with access to your medical records:

"A microchip that can be implanted under the skin to give doctors instant access to a patient's records yesterday won government approval, a step that could transform medical care but is raising alarm among privacy advocates.

"The tiny electronic capsule, the first such device to receive Food and Drug Administration approval, transmits a unique code to a scanner that allows doctors to confirm a patient's identity and obtain detailed medical information from an accompanying database." (10/14/04, Washington Post, via Yahoo News.)

Is this a good thing? Consider that some encounters go something like this:

MD: "What meds are you taking now?"

Patient: "I think it begins with L."

MD: "Lasix? Lanoxin?"

Patient: "I think it has an 'L' in it....say some more 'L' drugs, and I'll tell you which one it is."

Such dialogues make us yearn for readily accessible information. If a patient is disoriented, unconscious, or acutely psychotic, the hunt for data is hugely difficult, and more critical. Are implanted microchips the answer? Who gets the chips, who gets the scanners that read the chips, and exactly what data will be retrieved? I'm googling this today, and finding that the debate is in full swing.
Here's more:

"Doctors would scan patients like cans of soup at a grocery store. Instead of the pie, the patient's medical record would pop up on a computer screen. Emergency room doctors could scan unconscious car accident victims to check their blood type and medications and make sure they have no drug allergies. Surgeons could scan patients in the operating room to guard against cutting into the wrong person. Chips could be implanted in Alzheimer's patients in case they get lost."

I'm wondering, how is the database maintained? Even now, with electronic medical records, med lists may be incomplete, allergies missing, dictations pending. If the database isn't current, we might not even have the letter "L" to suggest what the meds are. Patients now have the right to request changes in their medical record, so the database might reflect only what the patient chooses to share. The patient's name would presumably be correct, and sometimes that alone might justify the chip.

Can we safeguard privacy with the chip, as we now protect medical information?

"The approval was immediately denounced by privacy advocates, who fear it could endanger patient privacy and mark a dangerous step toward a Big Brother future in which people will be tracked by the implants or required to have them inserted for surveillance, identification and other purposes.

"Once the technology is out there and is available, it raises the very real possibility that people in a position to require or demand it will begin to do that," said Katherine Albrecht, who has campaigned against such devices. "It would obviously be possible to inject one of these into everyone. In the post-9/11 world, we are already racing down the path to total surveillance. The only thing missing to clinch the deal has been the technology. This may fill that gap."

But if patients control the medical data in the database, and permit the scanners to retrieve the data, how does this violate privacy? I suppose the scanners and database might fall into the wrong hands. The same is true of paper charts, and the same safeguards presumably apply.

Here's the company's chief executive, discussing privacy:
"The accompanying scanners and software ensure that the personal information unlocked by the 16-digit code is only available to those designated by the patient, Silverman said.
"Even if people access your unique identification number, which would be extremely difficult to do, it doesn't give them access to your database. We're confident in the security measures we've taken," Silverman said.

The article also raises the issue of autonomy. Can patients be compelled to receive the chip? As I understand it, patients or their guardians must give consent for any injection...why not the chip also? (I don't see much discussion about chip removal - how difficult it is, how practical, or what complications might occur. If one can consent to the chip, one should be able to request its removal.) But critics warn that chips may become compulsory (in prisons or high-security situations in our post-9/11 world).

The company is optimistic about its future. "We believe that this (medical) application is going to drive acceptance of the product," said Angela Fulcher, vice president for marketing and communications. "If you have a chronic disease, where getting information to health care providers quickly may mean life or death, that population is going to be more accepting of this technology."

(Afterthought: As interns, we used to joke about the tattoos we wanted: "no code" on our chests, "no tubes" inscribed in our throats, "no cut-downs" over our veins. Perhaps tattoos won't be necessary, and microchips will express our last wishes clearly.)

(Update: Symtym beat me to this. According to his sources, it looks like the devices aren't easily removed.)

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